Uric Acid and Hypertension: An Update With Recommendations

Efficacy of angiotensin receptor blockers for nocturnal blood pressure reduction: a systematic review and meta-analysis

BACKGROUND

Nocturnal blood pressure (BP) is correlated with an increased risk of cardiovascular events and is an important predictor of cardiovascular death in hypertensive patients.

OBJECTIVE

Nocturnal BP control is of great importance for cardiovascular risk reduction. This systematic review and meta-analysis aimed to explore the efficacy of angiotensin receptor blockers (ARBs) for nocturnal BP reduction in patients with mild to moderate hypertension.

METHODS

PICOS design structure was used to formulate the data extraction. All statistical calculations and analyses were performed with R.

RESULTS

Seventy-seven studies with 13,314 participants were included. The overall analysis indicated that nocturnal BP drop varied considerably among different ARBs. Allisartan (13.04 [95% CI (-18.41, -7.68)] mmHg), olmesartan (11.67 [95% CI (-14.12, -9.21)] mmHg), telmisartan (11.11 [95% CI (-12.12, -10.11)] mmHg) were associated with greater reduction in nocturnal systolic BP. In the aspect of the nocturnal-diurnal BP drop ratio, only allisartan was greater than 1. While, the variation tendency of last 4-6 h ambulatory BP was basically consistent with nocturnal BP. Additionally, allisartan showed improvement effect in the proportion of patients with dipping BP pattern.

CONCLUSIONS

This study demonstrates that for patients with mild to moderate hypertension, allisartan, olmesartan and telmisartan have more advantages in nocturnal BP reduction among the ARBs, while allisartan can reduce nighttime BP more than daytime BP and improve the dipping pattern.

A nonlinear correlation between the serum uric acid to creatinine ratio and the prevalence of hypertension: a large cross-sectional population-based study

OBJECTIVE

To explore the relationship between the serum uric acid to creatinine (UA/Cr) ratio and the prevalence of hypertension.

METHODS

In this cross-sectional study, we included 8571 individuals from the China Health and Nutrition Survey. Logistic regression analysis and restricted cubic spline (RCS) were used to analyze the relationship between the UA/Cr ratio and hypertension.

RESULTS

Compared with individuals without hypertension, individuals with hypertension had higher UA/Cr ratios. Multivariate logistic regression analysis showed that a higher UA/Cr ratio was closely related to a higher risk of hypertension (as a continuous variable, OR: 1.054, 95% CI: 1.014-1.095, p = 0.007; as a categorical variable, Q3 vs. Q1, OR: 1.183, 95% CI: 1.011-1.384, p = 0.035; Q4 vs. Q1, OR: 1.347, 95% CI: 1.146-1.582, p < 0.001). Subgroup analysis revealed that the correlation between the UA/Cr ratio and hypertension risk was stable in all subgroups except for the subgroup with diabetes and the subgroup with a BMI ≥ 28 kg/m2 (p < 0.05). Sensitivity analysis confirmed the robustness of the relationship between a higher UA/Cr ratio and a higher risk of hypertension (p < 0.05). The RCS showed that the UA/Cr ratio was nonlinearly related to hypertension risk. Further threshold effect showed that only a UA/Cr ratio less than 5.0 was related to hypertension risk (OR: 1.178, 95% CI: 1.086-1.278, p < 0.001), and the 2-piecewise linear regression model was superior to the 1-line linear regression model (p < 0.05).

CONCLUSION

The UA/Cr ratio was associated with the prevalence of hypertension.

The Prevalence and Factors Associated with Coronary Heart Disease in Patients with Gout

Gout is associated with increased risk of cardiovascular disease (CVD) morbidity and mortality. Therefore, an association between coronary heart disease (CHD) and gout deserves careful examination.

AIM

. The aim of this study was to determine the prevalence of CHD and factors associated with CHD in patients (pts) with gout.

MATERIALS AND METHODS

. The study involved 286 male patients with gout, age 51.2 [42.8; 59.4] years (ys), disease duration 6.2 [3.8; 12.1] ys. All patients underwent standard clinical examination screening traditional risk factors (TRFs) of CVDs. We estimated the adjusted odds ratio (OR) and 95% confidence interval (95% CI).

RESULTS

. CHD was found in 111 out of the 286 pts (38.8%), MI had a history in 29.7%. Compared to individuals with CHD, participants without CHD were older (56.7[52.1; 61.1] vs 46.2[40.6; 53.4] ys), had longer duration of gout (9.3[4.7; 15.1] vs 5.6[3.3; 9.7] ys) (for all p < 0.05). Abdominal obesity (OR, 3.6; 95% CI, 1.2-10.9), family history of CHD (OR, 2.2; 95% CI, 1.3-3.7), disease duration of gout more 10 ys (OR, 2.8; 95% CI, 1.6-4.7), age of gout onset < 35 ys (OR, 5.5; 95% CI, 2.6-11.7), intraosseous tophi (OR, 3.03; 95% CI, 1.8-5.01), nephrolithiasis (OR, 1.7; 95% CI, 1.04-3.04), renal failure (OR, 5.6; 95% CI, 2.7-11.4), serum total cholesterol (TC), (OR, 1.6; 95% CI, 1.0-2.8), serum creatinine (OR, 2.5; 95% CI, 1.2-5.1), increased the risk for CHD in patients with a gout.

CONCLUSIONS

. The prevalence of CHD was 38.8% among individuals with gout (one-third of patients had a history of MI 29.7%). Our study showed that both TRFs of CVD and the severity of gout and a history of renal failure contribute to the development of CHD in patients with gout.

Influence of serum uric acid on bone and fracture risk in postmenopausal women

AIMS

Uric acid has been associated with several metabolic conditions, including bone diseases. Our objective here was to consider the relationship between serum uric acid levels and various bone parameters (bone mineral density, ultrasonographic parameters, vitamin D, PTH and serum calcium), as well as the prevalence and risk of fragility fracture.

METHODS

An observational and cross-sectional study carried out on 679 postmenopausal women, classified into 3 groups according to their serum uric acid levels, in whom bone densitometry, calcaneus ultrasounds, PTH, vitamin D and serum calcium analysis were done. Bone fractures were collected through the clinical history and lateral spinal X-ray.

RESULTS

Higher uric acid levels were found in women with older age, high BMI, diabetes, and high blood pressure. Higher levels of PTH and serum calcium were also observed, but did not effect on vitamin D. Serum uric acid was positively related to densitometric and ultrasonic parameters and negatively associated with vertebral fractures.

CONCLUSIONS

In the population of postmenopausal women studied, sUA levels were correlated with BMD, BUA, and QUI-Stiffness, and this correlation was independent of age and BMI. In addition, sUA was associated with a decrease in vertebral fractures. These results imply a beneficial influence of sUA on bone metabolism, with both a quantitative and qualitative positive effect, reflected in the lower prevalence of vertebral fractures.

Biomarkers of Parkinson's Disease: From Basic Research to Clinical Practice

Parkinson's disease (PD) is a common neurodegenerative disease characterized pathologically by dopaminergic neuron loss and the formation of Lewy bodies, which are enriched with aggregated α-synuclein (α-syn). PD currently has no cure, but therapeutic strategies are available to alleviate symptoms. Early diagnosis can greatly improve therapeutic interventions, but the clinical diagnosis of PD remains challenging and depends mainly on clinical features and imaging tests. Efficient and specific biomarkers are crucial for the diagnosis, monitoring, and evaluation of PD. Here, we reviewed the biomarkers of PD in different tissues and biofluids, along with the current clinical biochemical detection methods. We found that the sensitivity and specificity of single biomarkers are limited, and selecting appropriate indicators for combined detection can improve the diagnostic accuracy of PD.

Hyperuricemia - consequences of not initiating therapy. Benefits and drawbacks of treatment

Hyperuricemia, characterized by elevated levels of uric acid in the body, is associated with several health risks, including gout, urolithiasis and cardiovascular disease. Although treatment options are available, they can lead to hypersensitivity reactions, particularly with allopurinol therapy. This paper provides a comprehensive review of the consequences of hyperuricemia, the need for treatment and the potential adverse effects of allopurinol, illustrated by a case study. The study highlights the importance of careful consideration before initiating therapy, particularly in patients with comorbidities and concomitant medication. It emphasizes the need for vigilant monitoring and individualized treatment approaches to reduce adverse effects. In addition, genetic factors, particularly HLA-B*5801, play an important role in determining susceptibility to allopurinol hypersensitivity reactions. This paper highlights the importance of informed decision making in the management of hyperuricemia to optimize patient outcomes while minimizing the risks associated with treatment.

Assessing levels of uric acid and other cardiovascular markers in prehypertensive and hypertensive adults

INTRODUCTION

Although some studies have reported the association between uric acid (UA) and hypertension, evidence on prehypertension is still lacking. Therefore, the objective of this study was to determine the levels of UA and other cardiovascular markers among prehypertensive and hypertensive patients and assess their risk for developing arterial hypertension.

METHODS

157 individuals were recruited: 67 normotensive, 23 pre-hypertensive and 67 hypertensive. Blood samples were collected to measure biochemical parameters and anthropometric measurements and blood pressure were evaluated. We calculated the product of lipid accumulation and the visceral adiposity index to assess cardiovascular risk.

RESULTS

Our data showed an increase in UA levels in normotensives (4.9±1.3mg/dL), prehypertensives (5.2±1.3mg/dL) and hypertensives (5.9±1.6mg/dL) (p=0.004). We found a higher frequency of hyperuricemia in the hypertensive group (34.3%) than in the normotensive group (13.4%, p<0.05). Hypertensive volunteers had lower levels of HDL-C (p=0.004 and p=0.003) and higher body mass indexes (p<0.001 and p=0.007), glucose (p<0.001 and p=0.033), triglycerides (p=0.001 and p=0.005), visceral adiposity index (p<0.001 and p=0.002) and lipid accumulation product (p<0.001 and p=0.007) than normotensive and prehypertensive participants. We also observed that individuals with UA≥6.2mg/dL had an increased risk of hypertension of 4.77 (p=0.003) compared to individuals with levels≤4.3mg/dL.

CONCLUSION

Our results showed that UA is associated with increased blood pressure and unfavorable changes in anthropometric and biochemical parameters, which represent risk factors for hypertension and cardiovascular diseases.

Association of atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio and triglycerides-glucose index with hypertension: A gender-disaggregated analysis

This study assessed the association between atherosclerosis indices, serum uric acid to high-density lipoprotein cholesterol ratio (UHR) and triglyceride-glucose (TyG) index and the prevalence of hypertension among MASHAD cohort participants. In this cross-sectional study, the participants were divided into hypertensive and non-hypertensive subjects. The atherosclerosis indices, UHR and TyG index of the two groups were compared. Logistic regression analyses were used to determine the associations of these indices with hypertension in both sex. Receiver operating characteristic (ROC) curve analysis was used to establish the cut-off values for differentiating hypertensive from non-hypertensive subjects. p-values < .05 were considered statistically significant. Data related to 9675 subjects (3035 hypertensive and 6640 non-hypertensive) were analyzed. The mean values of atherosclerosis indices, UHR and TyG index were significantly higher (p < .001) in the hypertensives compared to non-hypertensives. After adjustment for potential confounders, among men, the TyG index (OR = 1.360; 95% CI: 1.210-1.530; p < .001) remained an independent factor for hypertension. Among women, atherogenic index of plasma (OR = 1.005; 95% CI: 1.002-1.007; p < .001), UHR (OR = 1.043; 95% CI: 1.026-1.060; p < .001) and TyG index (OR = 1.519; 95% CI: 1.376-1.677; p < .001) remained independent factors for hypertension. ROC curve analysis revealed that compare to the other indices, TyG index had a better predictive value for hypertension in both sex, especially in women.

A Study of Lipid Profile and the Correlation of Serum Uric Acid Levels in Patients With Hypertension

Aim We examine the lipid profile and correlation of serum uric acid (SUA) levels in cases of hypertension and normotensives. Methods The current observational study spanned between April 2022 and April 2024. Throughout the research, 200 patients were examined; 100 of these patients were classified as Stage 1 or Stage 2 hypertensive (as per the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure), while the other 100 served as controls, meaning they did not have hypertension or any other medical condition that could lead to elevated SUA levels. Results It was revealed that the proportion of hypertension was higher in males compared to females. Of the total male patients, most (41.1%) patients had grade 1 hypertension and grade 2 hypertension, while among females, 20% had grade 1 hypertension. It was seen that as age increases, systolic blood pressure (SBP) and diastolic blood pressure (DBP) also rise among the two study groups, although the correlation was not statistically significant between blood pressure level and age of study subjects. The hypertensive patients have increased SBP and DBP levels when compared to the control group, which is significant. The lipid profile shows that the hypertensive subjects had significantly higher mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), and triglyceride levels than controls. SUA levels were observed to be elevated in the hypertensive subjects implying a positive correlation between the level of uric acid and blood pressures. Conclusion We found evidence that hyperuricemia and hypertension go hand in hand. A statistically noteworthy positive connection was found between the systolic blood pressures and lipid profiles of the patients. Hypertensive patients were found to have hyperlipidemia, whereas normotensive controls had normal lipid profiles. Moreover, it was seen that there was a positive correlation between SBP and chronological age in hypertensive cases, although this was statistically not significant.

Signaling pathways in uric acid homeostasis and gout: From pathogenesis to therapeutic interventions

Uric acid is a product of purine degradation, and uric acid may have multiple physiologic roles, including the beneficial effects as an antioxidant and neuroprotector, maintenance of blood pressure during low salt ingestion, and modulation of immunity. However, overproduction of metabolic uric acid, and/or imbalance of renal uric acid secretion and reabsorption, and/or underexcretion of extrarenal uric acid, e.g. gut, will contribute to hyperuricemia, which is a common metabolic disease. Long-lasting hyperuricemia can induce the formation and deposition of monosodium urate (MSU) crystals within the joints and periarticular structures. MSU crystals further induce an acute, intensely painful, and sterile inflammation conditions named as gout by NLRP3 inflammasome-mediated cleavage of pro-IL-1β to bioactive IL-1β. Moreover, hyperuricemia and gout are associated with multiple cardiovascular and renal disorders, e.g., hypertension, myocardial infarction, stroke, obesity, hyperlipidemia, type 2 diabetes mellitus and chronic kidney disease. Although great efforts have been made by scientists of modern medicine, however, modern therapeutic strategies with a single target are difficult to exert long-term positive effects, and even some of these agents have severe adverse effects. The Chinese have used the ancient classic prescriptions of traditional Chinese medicine (TCM) to treat metabolic diseases, including gout, by multiple targets, for more than 2200 years. In this review, we discuss the current understanding of urate homeostasis, the pathogenesis of hyperuricemia and gout, and both modern medicine and TCM strategies for this commonly metabolic disorder. We hope these will provide the good references for treating hyperuricemia and gout.

Optimization of cardiovascular risk factor management in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms, current knowledge, and perspectives

The exact prognostic role of cardiovascular (CV) risk factors in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms (MPNs) remains unknown as it is often masked by other MPN-related features that bear strong prognostic impact on thrombotic risk. Therefore, current MPN treatment is not primarily guided by presence of CV risk factors. Treatment of CV risk factors in MPN patients usually mirrors that from the general population, despite the fact that CV risk factors in MPNs have their own specificities. Moreover, the optimal target levels for different metabolic deflections in MPNs (i.e., low-density lipoprotein, serum uric acid, or glycated hemoglobin levels) have not been defined. In the current review, we separately discuss the most important aspects of every individual CV risk factor (arterial hypertension, hyperlipidemia, chronic kidney disease, smoking, diabetes mellitus, hyperuricemia, and obesity and cachexia) in MPNs, summarize recent advances in the field, and propose future directions and research areas which may be needed to appropriately manage CV risk factors in MPNs.

Large-scale cross-ancestry genome-wide meta-analysis of serum urate

Hyperuricemia is an essential causal risk factor for gout and is associated with cardiometabolic diseases. Given the limited contribution of East Asian ancestry to genome-wide association studies of serum urate, the genetic architecture of serum urate requires exploration. A large-scale cross-ancestry genome-wide association meta-analysis of 1,029,323 individuals and ancestry-specific meta-analysis identifies a total of 351 loci, including 17 previously unreported loci. The genetic architecture of serum urate control is similar between European and East Asian populations. A transcriptome-wide association study, enrichment analysis, and colocalization analysis in relevant tissues identify candidate serum urate-associated genes, including CTBP1, SKIV2L, and WWP2. A phenome-wide association study using polygenic risk scores identifies serum urate-correlated diseases including heart failure and hypertension. Mendelian randomization and mediation analyses show that serum urate-associated genes might have a causal relationship with serum urate-correlated diseases via mediation effects. This study elucidates our understanding of the genetic architecture of serum urate control.

Serum uric acid level is associated with glomerular ischemic lesions in patients with primary membranous nephropathy: an analytical, cross-sectional study

To investigate the relationship between serum uric acid level and glomerular ischemic lesions (GIL) in patients with primary membranous nephropathy (PMN) and identify relevant risk factors. A total of 201 patients with PMN but normal renal function confirmed by renal biopsy executed in the Liaocheng People's Hospital, China, during January 2020-January 2023 were analyzed retrospectively. The enrolled patients were divided into a hyperuricemia group and a normal serum uric acid group (control group) according to their serum uric acid levels. Then, the participants were further divided into a non-GIL group or a GIL group based on the patient's renal biopsy results. The two groups' clinical and pathological data and meaningful indicators for differences were analyzed by binary logistic regression analysis. Additionally, the serum uric acid level prediction value on GIL was investigated using receiver operating characteristic (ROC) curves. Compared with the control group, the hyperuricemia group exhibited high serum uric acid, the prevalence of GIL, serum albumin, the prevalence of hypertension, and low-density lipoprotein cholesterol (LDL) levels (P < 0.05). Compared with the non-GIL group, the GIL group exhibited were older, had enhanced serum uric acid, serum albumin, and an increased prevalence of tubular atrophy/interstitial fibrosis (TA/IF), arteriolosclerosis, and low eGFR levels (P < 0.05). The binary logistic regression analysis revealed that the serum uric acid and the TA/IF are independent risk factors of GIL (P < 0.05). The AUC of ROC of GIL of PMN patients, predicted based on the serum uric acid concentration, was 0.736 (P < 0.05), wherein the threshold = 426.5 μmol/L and the Youden's index = 0.41. Serum uric acid concentration and the TA/IF are independent risk factors of GIL in patients with PMN, and the former exhibits prediction value on GIL in patients with PMN.

Impact of Hyperuricemia and Urate-Lowering Agents on Cardiovascular Diseases

The association between hyperuricemia and cardiovascular diseases has been studied for many years. Research has shown a link between high uric acid levels and increased risk of including coronary artery disease hypertension and other cardiovascular conditions. Urate-lowering therapy, particularly with xanthine oxidase inhibitors like allopurinol, has shown promising results in reducing blood pressure in individuals with hyperuricemia and hypertension. Clinical trials and studies have demonstrated significant reductions in both systolic and diastolic blood pressure with urate-lowering treatment. Urate-lowering treatment has shown a favorable effect on reducing systolic blood pressure and major adverse cardiovascular events in patients with previous cardiovascular disease. In terms of cardiovascular safety, clinical trials have indicated that xanthine oxidase inhibitors such as febuxostat are non-inferior to allopurinol and do not increase the risk of death or serious adverse events. Overall, these findings highlight the importance of managing hyperuricemia and utilizing urate-lowering therapy to mitigate the adverse cardiovascular effects associated with elevated uric acid levels.

Association of consumption of sugar-sweetened beverages with elevated blood pressure among college students in Yunnan Province, China

OBJECTIVE

Although some studies have examined the association between eating behaviour and elevated blood pressure (EBP) in adolescents, current data on the association between sugar-sweetened beverages (SSB) and EBP in adolescents in Yunnan Province, China, are lacking.

SETTING

Cluster sampling was used to survey freshmen at a college in Kunming, Yunnan Province, from November to December. Data on SSB consumption were collected using an FFQ measuring height, weight and blood pressure. A logistic regression model was used to analyse the association between SSB consumption and EBP, encompassing prehypertension and hypertension with sex-specific analyses.

PARTICIPANTS

The analysis included 4781 college students.

RESULTS

Elevated systolic blood pressure (SBP) and diastolic blood pressure (DBP) were detected in 35·10 % (1678/4781) and 39·34 % (1881/4781) of patients, respectively. After adjusting for confounding variables, tea beverage consumption was associated with elevated SBP (OR = 1·24, 95 % CI: 1·03, 1·49, P = 0·024), and carbonated beverage (OR = 1·23, 95 % CI: 1·04, 1·45, P = 0·019) and milk beverage (OR = 0·81, 95 % CI: 0·69, 0·95, P = 0·010) consumption was associated with elevated DBP in college students. Moreover, fruit beverage (OR = 1·32, 95 % CI: 1·00, 1·75, P = 0·048) and milk beverage consumption (OR = 0·69, 95 % CI: 0·52, 0·93, P = 0·014) was associated with elevated DBP in males.

CONCLUSION

Our findings indicated that fruit and milk beverage consumption was associated with elevated DBP in males, and no association was observed with EBP in females.

A Cohort Study on the Correlation Between Serum Uric Acid Trajectory and New-Onset Hypertension Based on Longitudinal Health Examination Data in Henan Area

Objective

To explore the correlation between serum uric acid (SUA) trajectories and new-onset hypertension, to provide scientific basis for the prevention and treatment of hypertension.

Methods

The study cohort was composed of 4372 subjects who met the inclusion criteria in the cohort study of Henan physical examination population. According to the SUA values of the subjects' physical examination from 2017 to 2019, three different SUA trajectory groups were determined by R LCTM tools, namely low stability group, medium stability group and high stability group. The incidence of hypertension during physical examination in 2020 was followed up, the cumulative incidence rate in each group was calculated by product limit method, and the correlation between different SUA trajectories and new-onset hypertension was analyzed by Cox proportional hazards regression model.

Results

The incidence rate of hypertension increased with the increase of SUA locus, which was 4.65%, 9.18% and 12.43% respectively, and the difference was statistically significant (P<0.001). After adjusting multiple confounding factors, such as gender, waist circumference (WC), blood pressure, body mass index (BMI), fasting plasma glucose (FPG) and blood lipid by Cox proportional hazards regression model, the risk of hypertension in SUA medium stability and high stability group was still 1.476 times (95% CI: 1.089~2.000) and 1.692 times (95% CI: 1.152~2.484) of low-stable SUA group (P<0.05).

Conclusion

The risk of hypertension increases with the increase of SUA level in the long-term normal range. It is necessary to carry out the intervention for hypertension with long-term normal high value to avoid the progress of hypertension disease, to achieve the purpose of early prevention of hypertension.

Gender Influence on XOR Activities and Related Pathologies: A Narrative Review

Taking into account the patient's gender is the first step towards more precise and egalitarian medicine. The gender-related divergences observed in purine catabolism and their pathological consequences are good examples of gender medicine differences. Uric acid is produced by the activity of xanthine oxidoreductase (XOR). The serum levels of both XOR activity and uric acid differ physiologically between the genders, being higher in men than in women. Their higher levels have been associated with gout and hypertension, as well as with vascular, cardiac, renal, and metabolic diseases. The present review analyzes the gender-related differences in these pathological conditions in relation to increases in the serum levels of XOR and/or uric acid and the opportunity for gender-driven pharmacological treatment.

Association between hyperuricemia and long-term mortality in patients with hypertension: results from the NHANES 2001-2018

Objective

The prevalence of hyperuricemia and hypertension is steadily increasing, and these conditions often share common risk factors. This study aimed to investigate the association among hyperuricemia, hypertension, and all-cause mortality in a nationally representative U.S. population.

Methods

Data for 38,644 participants were obtained from the National Health and Nutrition Examination Survey (NHANES) 2001-2018. Hyperuricemia was defined as a serum urate concentration >420 μmol/L in men and >360 μmol/L in women. Information regarding death outcomes was obtained through the National Death Index (NDI). Multivariate logistic regression, Cox proportional hazards models, and restricted cubic spline (RCS) analyses were used to evaluate the association between hyperuricemia and hypertension in all included participants, as well as long-term mortality in patients with hypertension.

Results

Among all participants, 6,956 (18.0%) had hyperuricemia, while 31,688 (82.0%) had nonhyperuricemia. According to the adjusted models, hyperuricemia was more strongly associated with hypertension (OR 2.04) than was non-hyperuricemia. During the median follow-up period of 78 months, both hyperuricemia (HR 1.48, 1.95) and hypertension (HR 1.42, 1.69) independently associated with the increased risk of all-cause mortality and cardiovascular mortality, respectively, with the highest risk observed in those with both conditions (HR 1.87, 2.82). RCS analyses revealed nonlinear J-shaped (for hypertension) and U-shaped (for both all-cause and cardiovascular mortality) relationships with serum urate levels.

Conclusions

Hyperuricemia is associated with an elevated risk of developing hypertension compared to non-hyperuricemia. Among patients with hypertension, those with hyperuricemia are more likely to experience all-cause and cardiovascular mortality during long-term follow-up.

The clinicopathological features and renal prognostic factors in pure membranous lupus nephritis-a large series cohort study from China

BACKGROUND

Membranous lupus nephritis (MLN) is a subepithelial immune deposition or its morphological sequelae with or without mesangial changes. Previous studies on the prognosis of MLN have shown relatively small sample sizes and short follow-up periods.

METHODS

Our study was a retrospective analysis of biopsy-proven MLN patients from January 2010 to January 2020 at Jinling Hospital in China. The clinical manifestations, pathological features, and renal outcomes of MLN patients were collected. The endpoint was defined as end-stage kidney disease (eGFR≤15 mL/min·1.73 m2 or need for renal replacement therapy) or a doubling of serum creatinine or an eGFR decline of more than 40%. We used Cox regression to analyze the risk factors for renal outcome and Kaplan-Meier curves were used to analyze renal survival rate.

RESULTS

In the total of 2884 lupus patients, we screened 535 MLN patients. 456 MLN patients were recruited with an average age of 34 ± 12 years, 87.8% for female patients and 62.1% patients of nephrotic syndrome with proteinuria of 2.67 g/24h. After follow-up of 78 (IQR, 47.3-113.0) months, 37 (8.1%) patients reached the renal endpoint. The 5-year and 10-year renal survival rates were 95.8% and 89.4%, respectively. 370 patients (81.1%) achieved complete remission, 43 patients (9.4%) had partial remission, and only 43 had no response. 34.4% MLN experienced a relapse. The Cox regression showed the risk factors that affect the renal prognosis include male, hypertension history, anemia, high uric acid, acute kidney injury, and interstitial fibrosis in the renal pathology.

CONCLUSIONS

MLN mostly manifested as nephrotic syndrome, with few renal dysfunctions. Although MLN had a high relapse rate, most patients had a response to immunosuppressants and had a good renal outcome.

Association Between Serum Uric Acid and Abdominal Aortic Calcification in Adults Aged 40 to 80 years: A Retrospective Cross-Sectional Study

There are numerous causes of abdominal aortic calcification (AAC), among which the relationship between serum uric acid and AAC still needs to be investigated further. The aim of this research was to ascertain whether serum uric acid is correlated with AAC. Our study included 3007 participants. We described the study population characteristics and utilized univariate analysis, stratified analysis, multiple equation regression analysis, smoothed curve fitting, and threshold effects analysis. AAC Total 24 score is used to reflect the range of aortic calcification at each vertebral level. As serum uric acid increased, the AAC Total 24 score first decreased and then increased. The fold point is located when serum uric is at 3.5 mg/dL. After adjusting for 16 covariates, the beta values for the groups with moderate and high serum uric acid levels were 0.34 and 0.53, respectively, compared with the low serum uric acid tertile group (P < .05). Our research indicates a negative correlation between serum acid level and AAC when serum uric acid <3.5 mg/dl, but it is positively correlated with the formation of AAC when serum uric acid >3.5 mg/dl.

The relationship between uric acid and in-hospital mortality in patients with type A acute aortic dissection: A retrospective single-center study

OBJECTIVE

To measure the preoperative uric acid (UA) concentration in patients with type A aortic dissection (TAAD), and to assess its value in predicting in-hospital mortality.

METHODS

A total of 747 patients with TAAD between January 2016 and December 2022 were enrolled. The patients were divided into a survivor group and a non-survivor group. The clinical data of the two groups were compared. Univariate and multiple logistic regression analyses were performed to determine risk factors related to in-hospital mortality.

RESULTS

Compared with survivors, non-survivors had significantly higher serum uric acid levels (486.84 ± 127.59 vs 419.49 ± 141.02, P = 0.040). The incidence of in-hospital death increased along with higher UA levels (3.8% vs 0.7%, P = 0.007). Serum UA ≥ 373.5 μmol/L had 89.5% sensitivity and 41.3% specificity for predicting in-hospital death (area under the curve = 0.659, 95% CI: 0.554-0.765, P < 0.05). In the multivariable logistic model, Serum UA ≥ 373.5 μmol/L was independently associated with in-hospital mortality (OR = 1.022, 95% CI: 1.000-1.044, P = 0.048).

CONCLUSION

Serum UA resulted as an independent predictor of adverse prognosis in patients with TAAD, and thus could be used as an effective tool for the risk-stratification of patients with TAAD.

Mechanisms and treatment of obesity-related hypertension-Part 1: Mechanisms

The prevalence of obesity has tripled over the past five decades. Obesity, especially visceral obesity, is closely related to hypertension, increasing the risk of primary (essential) hypertension by 65%-75%. Hypertension is a major risk factor for cardiovascular disease, the leading cause of death worldwide, and its prevalence is rapidly increasing following the pandemic rise in obesity. Although the causal relationship between obesity and high blood pressure (BP) is well established, the detailed mechanisms for such association are still under research. For more than 30 years sympathetic nervous system (SNS) and kidney sodium reabsorption activation, secondary to insulin resistance and compensatory hyperinsulinemia, have been considered as primary mediators of elevated BP in obesity. However, experimental and clinical data show that severe insulin resistance and hyperinsulinemia can occur in the absence of elevated BP, challenging the causal relationship between insulin resistance and hyperinsulinemia as the key factor linking obesity to hypertension. The purpose of Part 1 of this review is to summarize the available data on recently emerging mechanisms believed to contribute to obesity-related hypertension through increased sodium reabsorption and volume expansion, such as: physical compression of the kidney by perirenal/intrarenal fat and overactivation of the systemic/renal SNS and the renin-angiotensin-aldosterone system. The role of hyperleptinemia, impaired chemoreceptor and baroreceptor reflexes, and increased perivascular fat is also discussed. Specifically targeting these mechanisms may pave the way for a new therapeutic intervention in the treatment of obesity-related hypertension in the context of 'precision medicine' principles, which will be discussed in Part 2.

Serum uric acid predicts the development of atherosclerosis in women but not in men: A ten-year cohort study in China

BACKGROUND AND AIM

Atherosclerosis is becoming a significant health burden. Serum uric acid (SUA) is the final enzymatic product of purine metabolism and can contribute to the development of atherosclerosis. The aim of this study was to explore the possible predictive value of SUA in the development of atherosclerosis in a healthy Chinese population.

METHODS AND RESULTS

In this study, a total of 11,222 healthy subjects with no carotid plaque at baseline were enrolled and divided into sex-specific groups, and then the occurrence of carotid plaque during the follow-up time was documented. The association between carotid plaque and SUA levels was examined using Cox proportional-hazards regression models. The mean SUA level was 5.35 ± 1.41 mg/dL. A total of 2,911 individuals (25.94%) developed carotid plaque during the follow-up time, including 1,071 females and 1,840 males. After adjusting for potential confounding factors, the hazard ratio (HR) and 95% confidence interval (95% CI) in women for the occurrence of carotid plaque associated with SUA levels were 1.163 (1.017-1.330), but no significant correlation was found in men, as the HR was 1.050 (0.965-1.143).

CONCLUSION

Our results indicate that SUA levels predict the development of carotid plaque independent of traditional risk factors only in women.

The potential relationship between uric acid and the recovery in sudden sensorineural hearing loss

OBJECTIVE

Serum uric acid is proven to be associated with chronic hearing loss, but its effect on Sudden Sensorineural Hearing Loss (SSNHL) is unclear. This study aims to evaluate the prognostic values of serum uric acid levels in SSNHL patients.

METHODS

The clinical records of SSNHL patients were retrospectively reviewed. Patients were divided into different groups based on hearing recovery and audiogram type, and uric acid levels were compared. Based on uric acid levels, patients were categorized into normouricemia and hyperuricemia groups, and clinical features and hearing recovery were evaluated. Univariate and multivariate analyses were performed to identify prognostic factors.

RESULTS

In total, 520 SSNHL patients were included in this study, including 226 females and 294 males. In female patients, 186 patients were included in the normouricemia group, and 40 patients were enrolled in the hyperuricemia group. Significant differences were observed in uric acid levels, Total Cholesterol (TC), rate of complete recovery, and slight recovery between the two groups. In male patients, 237 subjects were categorized into the normouricemia group, and 57 patients were included in the hyperuricemia group. The rate of complete recovery and slight recovery was lower in the hyperuricemia group compared to the normouricemia group. All patients were further divided into good recovery and poor recovery groups based on hearing outcomes. The uric acid levels, initial hearing threshold, rate of hyperuricemia, and TC were lower in the good recovery group than the poor recovery group both in female and male patients. Binary logistic regression results showed that uric acid levels, initial hearing threshold, and hyperuricemia were associated with hearing recovery.

CONCLUSION

Hyperuricemia might be an independent risk factor for hearing recovery in SSNHL patients. Serum uric acid and initial hearing threshold possibly affected the hearing outcome in males and females with SSNHL.

LEVEL OF EVIDENCE

Level 4.

Serum uric acid: a futile bystander in endothelial function?

PURPOSE

This study aims to investigate the relationship between serum uric acid levels and endothelial function, oxidative stress, and hemodynamic parameters, and to determine if uric acid levels provide additional insights beyond traditional factors like ageing and hypertension in volunteers with low cardiovascular risk factors. Serum uric acid is known for its antioxidant properties, but it may also contribute to cardiovascular risk.

MATERIALS AND METHODS

The study enrolled 40 male participants, divided into three groups based on age and blood pressure status. Group 1 comprised younger participants, group 2 included older individuals without hypertension, and group 3 consisted of older patients with hypertension. The study assessed endothelial function using laser Doppler imaging and measured acetylcholine- and sodium nitroprusside-induced hyperaemia. The heat microcirculatory response was also examined in the presence of L-NAME, an inhibitor of NOS synthase. The study evaluated oxidative stress and arterial stiffness by measuring allantoin, angiotensin II, Homocitrulline/Lysine, and Chloro-Tyrosine/Tyrosine ratios, as well as by performing non-invasive measurements of aortic augmentation indexes and carotid-femoral pulse wave velocity.

RESULTS

The study found that uric acid levels did not differ significantly among the three groups. Augmentation indexes increased with ageing, but hypertension did not have an additional effect. Blood pressure and carotid-femoral pulse wave velocity differed among the groups, with the lowest values among younger participants and the highest values among older individuals with hypertension. Allantoin and angiotensin II levels did not differ among the groups. However, Homocitrulline/Lysine and Chloro-Tyrosine/Tyrosine ratios were significantly lower in young subjects. Correlation and multivariable analysis showed that uric acid had no effect on any of the studied parameters. Despite a strong association between ageing and systolic blood pressure with impaired endothelial function, oxidative stress, and arterial stiffness, only ageing retained a significant effect in the multivariable analysis.

CONCLUSION

In healthy or hypertensive adults with normal renal function, serum uric acid appears to be a futile bystander in endothelial function, oxidative stress, and arterial stiffness, in contrast to ageing, which reduces NO bioavailability. This study suggests that traditional factors such as ageing and hypertension should be the focus of clinical assessment and management of cardiovascular risk, rather than uric acid levels.

Efficient removal of purine compounds from solutions via biomass carbons derived from pomelo peel

The high purine diet could result in the increase of the level of blood uric acid, causing serious health problems such as hyperuricemia, gout, nephropathy and cardiovascular diseases. To find out a safe, cheap and super adsorption material for removing purines in stomach or pretreating high-purine beverages, we used different tissues of pomelo peel to prepare biomass carbon by drying, chemical modification and carbonization and then applied it to remove purine compounds in strong acidic solution, beer and soybean milk. The characteristic analysis of pomelo-peel-derived carbons (PPCs) indicated that the preparation methods significantly affected the structures and adsorption capacities of PPCs. Compared with the biomass carbon derived from bamboo, PPCs exhibited higher adsorption capabilities for purine compounds in strong acidic solution (adsorption rates > 99% in 15 min) and soybean milk (adsorption rates > 56% in 30 min) but slightly lower adsorption capabilities in beer (adsorption rates > 52% in 30 min). In addition, the adsorption capabilities of PPCs for purine compounds in beer and soybean milk were not obviously affected by temperatures. Therefore, PPCs are promising absorbents for applications in removing purine compounds from beverages to produce low-purine, healthier products for treating hyperuricemia. The strong adsorption capabilities of PPCs on purine compounds in strong acidic environment also provides a possibility of using the PPCs as food additives for removing purines in stomach for healthcare applications such as gout prevention after confirming their biosafety.

Associations between vitamin C intake and serum uric acid in US adults: Findings from National Health and Nutrition Examination Survey 2011-2016

BACKGROUNDS

Dietary factors has been found to influence serum uric acid (SUA) levels. We further explored the associations between dietary and supplemental vitamin C intake and SUA in a large population-based study.

METHODS

The cross-sectional study included 6308 participants (3146 males and 3162 females) aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2011-2016 in the United States. The dietary vitamin C was log-transformed for statistical analysis. Hyperuricemia was defined as SUA concentrations >420 umol/L in males or >360 umol/L in females. The associations of dietary vitamin C and supplemental vitamin C with SUA levels and hyperuricemia risk were evaluated using weighted linear regression models and weighted multivariate logistic regression models, and a subgroup analysis stratified by gender was also conducted.

RESULTS

In this large-scale database study, there was a negative association between dietary vitamin C (log transformed) and SUA levels in US adults (β = -7.27, 95% CI: -11.58, -2.97). The inverse relationship existed among males but not females (P for interaction = 0.02). There was inverse correlation between dietary vitamin C (log transformed) and hyperuricemia risk (OR = 0.68, 95% CI: 0.57, 0.81), especially in males compared to females determined through an interaction test (P = 0.04). There were no associations between supplemental vitamin C and SUA levels (β = 1.00 (95% CI: -4.44, 6.44) or hyperuricemia risk (OR = 0.98 (95% CI: 0.78, 1.24). High-dosage supplemental vitamin C (>300 mg) and hyperuricemia risk were not associated (OR = 1.04, 95% CI: 0.69, 1.56).

CONCLUSIONS

This study demonstrated that there were negative associations between dietary vitamin C and SUA levels and hyperuricemia risk among US adults. The inverse correlations between dietary vitamin C and hyperuricemia risk were more significant in males compared to females. There were no associations between supplemental vitamin C and SUA levels or hyperuricemia risk.

Exploring the Multifaceted Nexus of Uric Acid and Health: A Review of Recent Studies on Diverse Diseases

The prevalence of patients with hyperuricemia or gout is increasing worldwide. Hyperuricemia and gout are primarily attributed to genetic factors, along with lifestyle factors like consuming a purine-rich diet, alcohol and/or fructose intake, and physical activity. While numerous studies have reported various comorbidities linked to hyperuricemia or gout, the range of these associations is extensive. This review article focuses on the relationship between uric acid and thirteen specific domains: transporters, genetic factors, diet, lifestyle, gout, diabetes mellitus, metabolic syndrome, atherosclerosis, hypertension, kidney diseases, cardiovascular diseases, neurological diseases, and malignancies. The present article provides a comprehensive review of recent developments in these areas, compiled by experts from the Young Committee of the Japanese Society of Gout and Uric and Nucleic Acids. The consolidated summary serves to enhance the global comprehension of uric acid-related matters.

Associations of serum uric acid with cardiovascular disease risk factors: a retrospective cohort study in southeastern China

OBJECTIVE

To evaluate the associations between serum uric acid (SUA) levels and cardiovascular disease (CVD) risk factors, focusing on potential sex-specific differences.

DESIGN

A retrospective cohort study.

SETTING

A large community-based survey was conducted every two years from 2010 to 2018 in Hangzhou, Zhejiang Province, outheastern China.

PARTICIPANTS

6119 participants aged 40 years and above who underwent at least three times of physical examinations were enrolled.

METHODS

Participants were categorised into four groups (Q1-Q4) based on baseline SUA quartiles within the normal range, with hyperuricaemia (HUA) as the fifth group. The Q1 was the reference. By stratifying participants by gender, the relationships between SUA levels and systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) and total cholesterol (TC) were investigated using linear regression models in the generalised estimating equation. Additionally, the associations of elevated SUA levels and HUA with hypertension, hyperglycaemia and dyslipidaemia were correspondingly examined using multivariate logistic regression models.

RESULTS

After adjusting for confounding variables, we found positive associations between SUA levels and SBP, DBP, FBG and TC in women, and with TC in men (p<0.01). Likewise, elevated SUA quartiles and HUA were linked to increased dyslipidaemia risk in both sexes, and increased hyperglycaemia risk only in women, with HRs (95% CI) of 1.64 (1.05 to 2.55) and 2.37 (1.47 to 3.81) in the Q4 and HUA group, respectively. Women with HUA had higher hypertension risk (HR=1.45, 95% CI 1.21 to 1.73), while no such association was observed in men. Stratified analyses revealed significant associations between elevated SUA levels and CVD risk factors in postmenopausal and non-obese women.

CONCLUSIONS

Elevated SUA levels increase the risk of dyslipidaemia in both sexes. SUA levels within normal range and HUA are positively associated with hyperglycaemia and hypertension in postmenopausal women, but not in men.

Relationship between serum uric acid and hypertension in the general US population aged 20 years and older: A cross-sectional study based on NHANES 2007 to 2016

The aim of this study was to investigate the association between serum uric acid (UA) levels and hypertension in American individuals 20 years of age and older. We used continuous cross-sectional surveys from the National Health and Nutrition Examination Survey in the United States from 2007 to 2016. Our selected population was adults aged 20 years and older in the United States. We examined the association between serum UA and risk of hypertension using weighted univariate logistic regression analysis, weighted multivariate logistic regression analysis, weighted subgroup analysis, and weighted restricted cubic spline analysis. Serum UA was significantly linked with hypertension in a multivariate logistic regression model adjusted for all variables (odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.15-1.28, P < .001). Furthermore, dividing serum UA into quartiles (Q) revealed an association between elevated serum UA and increased risk of hypertension [Q1 = (OR: 1.00), Q2 = (OR: 1.13, 95% CI: 0.95-1.37, P = .159), Q3 = OR: 1.30, 95% CI: 1.10-1.52, P = .002), Q4 = OR: 1.94, 95% CI: 1.58-2.38, P = .161). Additionally, we conducted subgroup analyses for age, sex, race, education, marital status, diabetes status, smoking, and alcohol use and discovered that these factors had a moderating effect on serum UA and hypertension (P < .05). Last but not least, we looked into the nonlinear link between serum UA and hypertension using weighted restricted cubic splines and discovered that there was no such relationship. The segmental effect of serum UA and hypertension, with an inflection point of 5.079 (mg/dL), was discovered in our gender-stratified study. And in analyses stratified by race and marital status, we similarly found a dose-response relationship between UA and hypertension among Hispanics and unmarried people. Our study showed a positive correlation between serum UA and hypertension.

Associations between obesity parameters and hyperuricemia by sex, age, and diabetes mellitus: A nationwide study in Korea

OBJECTIVE

We investigated the associations between obesity parameters and the risk of hyperuricemia among Korean adults by sex, age, and diabetes mellitus status.

METHODS

This study analyzed data from 17,753 adults from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016-2018. Multivariable logistic regression analyses were conducted to examine the associations of body mass index (BMI), waist circumference (WC), and general and abdominal obesity with the risk of hyperuricemia (serum uric acid ≥7.0 mg/dL in men and ≥6.0 mg/dL in women).

RESULTS

Of all the participants, 12.7% (n = 2256) had hyperuricemia. The age-adjusted mean serum uric acid levels increased significantly with increasing BMI and WC (P for trend <0.001). The adjusted odds ratios (ORs) of hyperuricemia increased as BMI and WC increased in both sexes (P for trend <0.001). General (OR 1.98, 95% confidence interval [CI]: 1.69-2.32) and abdominal (OR 2.21, 95% CI: 1.89-2.58) obesity in men and general (OR 3.26, 95% CI: 2.60-4.09) and abdominal (OR 3.43, 95% CI: 2.69-4.37) obesity in women were associated with higher risks of hyperuricemia. These associations were prominent in women. The association between abdominal obesity and hyperuricemia persisted after additional adjustments for BMI in both sexes. Significant interactions were observed in younger adults and individuals without diabetes mellitus.

CONCLUSION

Increased BMI and WC, and general and abdominal obesity, may be important risk factors for hyperuricemia in both sexes. Women, young adults, and individuals without diabetes mellitus require particular attention to prevent obesity and hyperuricemia.

Uric acid plasma levels are associated with C-reactive protein concentrations and the extent of coronary artery lesions in patients with acute coronary syndromes

Many studies have pointed out that inflammation plays a pivotal role in pathophysiology of acute coronary syndromes (ACS) because several inflammatory molecules impair the endothelial functions in the coronary circulation and promote atherothrombotic events. Recently, many clinical/experimental evidences indicate that elevated plasma levels of uric acid (UA) might be considered a risk factor for developing ACS. It has been reported that elevated UA doses impair physiologic functions of endothelial cells, shifting them toward a pro atherothrombotic phenotype. In the present manuscript, we investigated the relationship between UA plasma levels, inflammatory burden, and extension of coronary atherosclerotic disease in patients with ACS. Patients with a clinical presentation of ACS (ST-elevated and non-ST-elevated myocardial infarction) admitted to the Vanvitelli Catheterization Laboratory at Monaldi Hospital in 2019, before the COVID-19 pandemia, were retrospectively analyzed. Biochemical profile, type of ACS presentation, as well as extension of coronary atherosclerosis were assessed. A total of 132 ACS patients were included in the analysis, and grouped into 3 tertiles according to the UA values (UA < 4.72 mg/dl, UA between 4.72 and 6.15 mg/dl, and UA > 6.15 mg/dl). Patients with UA plasma levels ≥ 6.15 mg/dL showed higher levels of C-reactive protein (mean of 5.1 mg/dL) as compared to patients with lower UA plasma levels. Moreover, the former group of patients showed higher levels of cardiac troponin and CPK, and presented more often with multivessel disease and complex coronary stenosis (type C of Ellis classification). Even though monocentric and with limited sample size, the present study shows that plasma levels of UA and hs-CRP are elevated in ACS patients and are associated with a more severe coronary disease, suggesting a potential role of UA in the pathophysiology of acute coronary events.

Tetra-ARMS PCR analysis of angiotensinogen AGT T174M (rs4762) genetic polymorphism in diabetic patients: a comprehensive study

Background and purpose

Hypertension (HTN) is a multifactorial chronic disease that poses a significant global health burden and is associated with increased mortality rates. It often coexists with other conditions, such as cardiovascular, liver, and renal diseases, and has a strong association with diabetes mellitus. Insulin resistance and endothelial dysfunction commonly occur in individuals with both HTN and type 2 diabetes mellitus (T2DM). Genetic factors, along with environmental and pathological factors, play a role in the development of HTN. Recent studies have revealed the influence of single nucleotide polymorphisms (SNPs) in various genes on HTN. In this study, we aimed to investigate the genetic polymorphism of angiotensinogen (AGT) T174M (rs4762) and its association with HTN in diabetic patients.

Methods

A total of 300 participants were enrolled in this study and divided into three groups: control, hypertensive, and hypertensive diabetic. Blood samples were collected, and predetermined biochemical parameters were assessed. Genotyping of the AGT T174M (rs4762) gene was conducted using Tetra ARMS PCR with specific primers.

Results

The study findings revealed a significant association between AGT T174M (rs4762) genotype and HTN in diabetic patients within the Pakistani population. The C/T genotype of AGT T174M (rs4762) was found to be significant in both the hypertensive and hypertensive diabetic participants compared to the control group. This genotype was identified as a risk factor for developing HTN in both the hypertensive and hypertensive diabetic participants.

Conclusion

This study demonstrates a significant association between AGT T174M (rs4762) genetic polymorphism and HTN in diabetic patients. The C/T genotype of AGT T174M (rs4762) may serve as a potential marker for identifying individuals at risk of developing HTN, specifically in the hypertensive and hypertensive diabetic populations. Further research is warranted to elucidate the underlying mechanisms and validate these findings in larger cohorts.

Elevated Serum Uric Acid Is Associated With Gestational Diabetes Mellitus: An Observational Cohort Study

CONTEXT

Elevated serum uric acid may be closely related to the occurrence of gestational diabetes mellitus (GDM).

OBJECTIVE

We aimed to elucidate the relationship between changes in serum uric acid before 24 weeks of gestation and the risk of GDM and associated adverse pregnancy outcomes and provide clinical epidemiological evidence for the involvement of uric acid in the etiology of GDM.

METHODS

We conducted a retrospective cohort study of 23 843 singleton pregnant women between February 2018 and June 2022. The exposure factor was serum uric acid before 24 weeks of gestation, primary outcome was gestational diabetes diagnosed at 24 to 28 weeks of gestation, and secondary outcomes were GDM A2 (GDM requiring pharmacotherapy), GDM combined with pre-eclampsia, preterm delivery, and large for gestational age infants. Adjusted risk ratios (RRs) were calculated using multivariate predictive marginal proportions from logistic regression models.

RESULTS

Among 23 843 singleton pregnant women, 3204 (13.44%) were diagnosed with GDM at 24 to 28 weeks of gestation, and elevated uric acid before 24 weeks of gestation was strongly associated with the risk of GDM. Compared with uric acid <240 µmol/L, the RR for GDM was 1.43 (95% CI 1.29-1.56) when uric acid was between 240 and 300 µmol/L; when uric acid was >300 µmol/L, the RR for GDM was 1.82 (95% CI 1.55-2.15). In secondary outcomes uric acid had a similar relationship with GDM A2, preterm birth, and GDM combined with pre-eclampsia.

CONCLUSION

Elevated uric acid levels before 24 weeks of gestation are associated with subsequent GDM; the best time to test for uric acid is before 18 weeks of gestation. Pregnant women with low and intermediate risk for GDM development may benefit more from serum uric acid measurements before 18 weeks of gestation.

Positive correlation between fatty liver index and hyperuricemia in hypertensive Chinese adults: a H-type hypertension registry study

Background

Few studies have examined the relationship between fatty liver index (FLI) and hyperuricemia (HUA). This study explores the relationship between FLI and HUA in hypertensive patients.

Methods

A total of 13,716 hypertensive subjects were included in the current study. FLI, a simple index calculated from triglycerides (TG), waist circumference (WC), body mass index (BMI), and γ -glutamyltransferase (GGT), was used as a useful predictor of nonalcoholic fatty liver disease (NAFLD) distribution. HUA was defined as serum uric acid ≥ 360 μmol/L for females and ≥ 420 μmol/L for males.

Results

The mean value of total FLI was 31.8 ± 25.1. Multiple logistic analyses revealed a significant positive correlation between FLI and HUA (OR, 1.78; 95% CI: 1.69-1.87). A subgroup analysis demonstrated that the correlation between FLI (< 30 vs. ≥ 30) and HUA was significant in both sexes (P for interaction = 0.006). Further analyses stratified by sex indicated a positive correlation between FLI and HUA prevalence among male and female subjects. However, the correlation between FLI and HUA was stronger in female subjects than in males (male: OR, 1.70; 95% CI: 1.58-1.83; female: 1.85; 95% CI: 1.73-1.98).

Conclusion

This study demonstrates a positive correlation between FLI and HUA in hypertensive adults, but stronger in females than males.

Uric acid level in climacteric women and its association with clinical and metabolic parameters

Climacteric women often experience unfavorable metabolic changes. Consequently, identifying markers that may contribute to such undesirable changes is imperative. This study aimed to evaluate serum uric acid (UA) concentration and its association with metabolic and clinical parameters in climacteric women. We selected 672 women between 40 and 65 years and performed interviews, biochemical analyses, blood pressure, and anthropometric measurements. UA levels were determined using the enzymatic-colorimetric method. We compared variables according to the quartiles of UA using the Kruskal-Wallis test. The mean UA level was 4.9 ± 1.5 mg/dl, ranging from 2.0 to 11.6 mg/dl. We found that UA levels greater than 4.8 mg/dl were associated with adverse metabolic parameters in climacteric women. For all anthropometric and biochemical variables, we observed significantly better results in women who had lower UA levels (p < 0.05). Similarly, we observed a significant increase in blood pressure, frequency of metabolic syndrome, and cardiovascular risk as UA levels increased (p < 0.05). Our findings showed that climacteric women with high levels of UA were more likely to have adverse metabolic and clinical parameters than those with lower UA levels. Further studies may determine the causal relationship between UA and metabolic changes in climacteric women.

Gout and hyperuricaemia: modifiable cardiovascular risk factors?

Gout and hyperuricaemia are two clinical situations associated with an elevated risk of developing cardiovascular (heart failure, myocardial infarction, stroke) and metabolic and renal complications. One reason is probably related to the fact that the prevalence of hyperuricaemia and gout is high in clinical situations, which themselves involve a high cardiovascular risk, such as hypertension, diabetes, chronic kidney disease or obesity. However, recent studies suggest that hyperuricaemia may promote cardiovascular complications independently of other cardiovascular risk factors, by inducing chronic inflammation, oxidative stress, and endothelial dysfunction. The questions that arise today concern primarily the treatment of asymptomatic hyperuricaemia. Should it be treated to decrease the patients' cardiovascular risk and if so, starting from which level and towards which target? There are now several pieces of evidence indicating that this might be useful, but data from large studies are not unanimous. This review will discuss this issue as well as new well-tolerated treatments, such as febuxostat or SGLT2 inhibitors, which lower uric acid levels, prevent gout and lower the risk of cardio-renal events.

Valproate-Induced Metabolic Syndrome

Valproic acid (VPA) and its salts (sodium calcium magnesium and orotic) are psychotropic drugs that are widely used in neurology and psychiatry. The long-term use of VPA increases the risk of developing adverse drug reactions (ADRs), among which metabolic syndrome (MetS) plays a special role. MetS belongs to a cluster of metabolic conditions such as abdominal obesity, high blood pressure, high blood glucose, high serum triglycerides, and low serum high-density lipoprotein. Valproate-induced MetS (VPA-MetS) is a common ADR that needs an updated multidisciplinary approach to its prevention and diagnosis. In this review, we consider the results of studies of blood (serum and plasma) and the urinary biomarkers of VPA-MetS. These metabolic biomarkers may provide the key to the development of a new multidisciplinary personalized strategy for the prevention and diagnosis of VPA-MetS in patients with neurological diseases, psychiatric disorders, and addiction diseases.

Dysuricemia-A New Concept Encompassing Hyperuricemia and Hypouricemia

The importance of uric acid, the final metabolite of purines excreted by the kidneys and intestines, was not previously recognized, except for its role in forming crystals in the joints and causing gout. However, recent evidence implies that uric acid is not a biologically inactive substance and may exert a wide range of effects, including antioxidant, neurostimulatory, proinflammatory, and innate immune activities. Notably, uric acid has two contradictory properties: antioxidant and oxidative ones. In this review, we present the concept of "dysuricemia", a condition in which deviation from the appropriate range of uric acid in the living body results in disease. This concept encompasses both hyperuricemia and hypouricemia. This review draws comparisons between the biologically biphasic positive and negative effects of uric acid and discusses the impact of such effects on various diseases.

Serum uric acid to creatinine ratio is a useful predictor of all-cause mortality among hypertensive patients

BACKGROUND

Many of the existing research studies have shown that serum uric acid (SUA) is a predictor of renal disease progression. More recently, studies have suggested an association between renal function-normalized SUA and all-cause mortality in adults. This study aims to examine the association between the ratio of SUA to creatinine (SUA/Cr) and all-cause mortality with a focus on hypertensive patients.

METHODS

This study is based on 2,017 participants, of whom 916 were male (mean age, 67 ± 11 years) and 1,101 were female (mean age, 69 ± 9 years). All participants were part of the Nomura Cohort Study in 2002 (cohort 1) and 2014 (cohort 2), as well as the follow-up period (2002 follow-up rate, 94.8%; 2014 follow-up rate, 98.0%). We obtained adjusted relative risk estimates for all-cause mortality from a basic resident register. In addition, we employed a Cox proportional hazards model and adjusted it for possible confounders to determine the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

Of the total participants, 639 (31.7%) were deceased; of these, 327 (35.7%) were male and 312 (28.3%) were female. We found an independent association between a higher ratio of SUA/Cr and a higher risk of all-cause mortality in female participants only (HR, 1.10; 95% CI, 1.02-1.18). The multivariable-adjusted HRs (95% CI) for all-cause mortality across quintiles of baseline SUA/Cr were 1.28 (0.91-1.80), 1.00, 1.38 (0.95-1.98), 1.37 (0.94-2.00), and 1.57 (1.03-2.40) for male participants, and 0.92 (0.64-1.33), 1.00, 1.04 (0.72-1.50), 1.56 (1.06-2.30), and 1.59 (1.06-2.38) for female participants. When the data were further stratified on the basis of age (< 65 or ≥ 65 years), body mass index (< 22.0 or ≥ 22.0 kg/m²), estimated glomerular filtration rate (< 60 or ≥ 60 mL/min/1.73 m²), and presence of SUA-lowering medication, trends similar to those of the full population were found in all groups.

CONCLUSION

Baseline SUA/Cr is independently and significantly associated with future all-cause mortality among hypertensive patients.

Longitudinal uric acid has nonlinear association with kidney failure and mortality in chronic kidney disease

We investigated the shape of the relationship between longitudinal uric acid (UA) and the hazard of kidney failure and death in chronic kidney disease (CKD) patients, and attempted to identify thresholds associated with increased hazards. We included CKD stage 3-5 patients from the CKD-REIN cohort with one serum UA measurement at cohort entry. We used cause-specific multivariate Cox models including a spline function of current values of UA (cUA), estimated from a separate linear mixed model. We followed 2781 patients (66% men, median age, 69 years) for a median of 3.2 years with a median of five longitudinal UA measures per patient. The hazard of kidney failure increased with increasing cUA, with a plateau between 6 and 10 mg/dl and a sharp increase above 11 mg/dl. The hazard of death had a U-shape relationship with cUA, with a hazard twice higher for 3 or 11 mg/dl, compared to 5 mg/dl. In CKD patients, our results indicate that UA above 10 mg/dl is a strong risk marker for kidney failure and death and that low UA levels below 5 mg/dl are associated with death before kidney failure.

Concentration of serum uric acid in patients with Renal Artery Stenosis and Hypertension prEdict Future nephropathy and death: C-RASHEF study

Since both serum uric acid (SUA) and renal artery stenosis (RAS) are associated with atherosclerotic events and renal events, it is interesting to investigate whether SUA could predict long-term outcome in patients with RAS. Patients were enrolled from inpatients from 2010 to 2014, must be ≥40-year-old. There were 3269 hypertensive patients enrolled, including 325 RAS patients. Endpoints included all-cause death and new or worsening nephropathy (NNP). In analysis for all-cause mortality, associations between SUA and risk of all-cause mortality were an arising curve in total population, a U-shape curve in non-RAS population, and an arising curve in RAS population. When RAS was involved in multivariate analysis, association between SUA and risk of all-cause mortality was still an arising curve in total population. In analysis for NNP, associations between SUA and risk of NNP were a declining curve in total population, not significant in non-RAS population, and a U-shape curve in RAS population. When RAS was involved in multivariate analysis, association between SUA and risk of NNP in total population was no longer significant. Not only association curve of SUA with mortality in non-RAS patients is different from association curve in RAS patients, but also association curve of SUA with NNP in non-RAS patients is different from association curve in RAS patients. The authors conclude that mechanisms of uric acid for mortality and NNP in RAS patients are different from non-RAS patients. In addition to renal vascular obstruction, uric acid is another significant factor for NNP and death in RAS patients.

Association of first trimester serum uric acid with preeclampsia: an observational cohort study with propensity score matching

To elucidate whether uric acid changes in early pregnancy are associated with the development of preeclampsia and their association with preeclampsia-related adverse pregnancy outcomes. We conducted a retrospective cohort study of 4725 singleton pregnant women between January 2017 and July 2019 using propensity score matching. The primary outcome of the cohort was preeclampsia, and the secondary outcomes were preterm delivery, preterm preeclampsia and low birth weight infants. Multivariable predicted marginal proportions from logistic regression models were used to compute adjusted risk ratios. The quantitative-effect relationship between serum uric acid and preeclampsia development was observed by a dose‒response graph, and the effect of serum uric acid on the week of gestation at delivery was assessed using the Kaplan‒Meier method and the log-rank test. The risk of preeclampsia development increased with higher serum uric acid levels. After adjusting for confounders, the risk ratio for the development of preeclampsia with uric acid levels ≥240 µmol/l was 1.25 (95% CI: 0.96-1.65) compared with the group with uric acid levels <240 µmol/l. In the subgroup analysis of KM (Kaplan-Meier) curves, the gestational week at delivery was earlier when uric acid levels ≥240 µmol/l occurred at 8-12 weeks of gestation. Elevated serum uric acid levels before 20 weeks of gestation are associated with the development of preeclampsia, especially in the first 8-12 weeks of gestation, and the effect is attenuated with increasing gestational weeks, which suggests that elevated uric acid levels in early pregnancy may be a causative factor in preeclampsia. Elevated serum uric acid levels before 20 weeks of gestation are associated with the development of preeclampsia, especially in the early 8-12 weeks of gestation, and the effect attenuates with increasing gestational weeks, which suggest that elevated uric acid in early pregnancy may be a causative factor in preeclampsia.

Association of serum uric acid with the risk of developing hypertension: A prospective cohort study with mediation analysis

Elevated serum uric acid (SUA) is associated with the incidence of hypertension, but whether relevant metabolic factors have mediating effects is not certain. Our study was based on a functional community cohort established in Beijing. In 2015, a total of 7482 individuals without hypertension were recruited and followed up until 2019. Multivariate logistic regression analysis was used to investigate the association between SUA and hypertension. Cross-lagged panel analysis and mediation analysis were used to explore the effects of metabolic factors on the association between SUA and incident hypertension. During the average 4-year follow-up, the cumulative incidence of hypertension was 10.9% (n = 580). SUA was an independent risk factor for hypertension, and the RRs (95% CI) for subjects with baseline SUA levels in quartile 2, quartile 3 and quartile 4 were 1.20 (0.88-1.63), 1.50 (1.10-2.05), and 1.57 (1.11-2.22) compared to those in quartile 1, respectively. The cross-lagged panel analysis showed that the increases in Cr, TG, LDL, ALT, AST and WBC occurred after SUA increased (P < 0.001). Among these factors, TG, WBC and ALT played an intermediary role in both men (TG: 14.76%; WBC: 11.61%; ALT: 15.93%) and women (TG: 14.55%; WBC: 8.55%; ALT: 6.89%). The elevated SUA concentration was an independent risk factor for hypertension in the Chinese population, and TG, WBC and ALT had important mediating effects on the association between SUA and hypertension.

The Impact of Obesity Surgery on Serum Uric Acid in People With Severe Obesity: A Retrospective Study

Studies indicate an association between hyperuricemia (HUA) and metabolic syndrome risk factors. On the other hand, obesity is a major modifiable and independent risk factor for HUA and gout. However, evidence concerning the effects of bariatric surgery on serum uric acid levels is limited and not completely clarified. This retrospective study was carried out with 41 patients who underwent sleeve gastrectomy (n = 26) and Roux-en-Y gastric bypass (n = 15) from September 2019 to October 2021. Anthropometric, clinical, and biochemical data, including uric acid blood urea nitrogen and creatinine fasting blood sugar (FBS), serum triglyceride (TG), and serum cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), were measured preoperatively and postoperative 3, 6 and 12 months. From baseline to 6 and 12 months, bariatric surgery resulted in a significant decrease in serum uric acid of patients with severe obesity (p < 0.001). The decreases in serum FBS, TG, and cholesterol of patients were significant during 6 and 12 months of follow-up (p < 0.05). However, the HDL increase of patients was not statistically significant in 6 and 12 months (p > 0.05). Besides, although patients' serum level of LDL decreased significantly during the 6 months of follow-up (p = 0.007), it was not significant after 12 months (p = 0.092). Bariatric surgery significantly reduces serum uric acid levels. Therefore, it may be an effective supplementary therapy for lowering serum uric acid concentrations in morbidly obese patients.

Valorization of Chicken Slaughterhouse Byproducts to Obtain Antihypertensive Peptides

Hypertension (HTN) is the leading cause of premature deaths worldwide and the main preventable risk factor for cardiovascular diseases. Therefore, there is a current need for new therapeutics to manage this condition. In this regard, protein hydrolysates containing antihypertensive bioactive peptides are of increasing interest. Thus, agri-food industry byproducts have emerged as a valuable source to obtain these hydrolysates as they are rich in proteins and inexpensive. Among these, byproducts from animal origin stand out as they are abundantly generated worldwide. Hence, this review is focused on evaluating the potential role of chicken slaughterhouse byproducts as a source of peptides for managing HTN. Several of these byproducts such as blood, bones, skins, and especially, chicken feet have been used to obtain protein hydrolysates with angiotensin-converting enzyme (ACE)-inhibitory activity and blood pressure-lowering effects. An increase in levels of endogenous antioxidant compounds, a reduction in ACE activity, and an improvement of HTN-associated endothelial dysfunction were the mechanisms underlying their effects. However, most of these studies were carried out in animal models, and further clinical studies are needed in order to confirm these antihypertensive properties. This would increase the value of these byproducts, contributing to the circular economy model of slaughterhouses.

Moderate hyperuricaemia ameliorated kidney damage in a low-renin model of experimental renal insufficiency

Uric acid has promoted renal fibrosis and inflammation in experimental studies, but some studies have shown nephroprotective effects due to alleviated oxidative stress. We studied the influence of experimental hyperuricaemia in surgically 5/6 nephrectomized rats. Three weeks after subtotal nephrectomy or sham operation, the rats were allocated to control diet or 2.0% oxonic acid (uricase inhibitor) diet for 9 weeks. Then blood, urine and tissue samples were taken, and renal morphology and oxidative stress were examined. Inflammation and fibrosis were evaluated using immunohistochemistry and real-time PCR (RT-PCR). Remnant kidney rats ingesting normal or oxonic acid diet presented with ~60% reduction of creatinine clearance and suppressed plasma renin activity. Oxonic acid diet increased plasma uric acid levels by >80 μmol/L. In remnant kidney rats, moderate hyperuricaemia decreased glomerulosclerosis, tubulointerstitial damage and kidney mast cell count, without influencing the fibrosis marker collagen I messenger RNA (mRNA) content. In both sham-operated and 5/6 nephrectomized rats, the mast cell product 11-epi-prostaglandin-F_2α excretion to the urine and kidney tissue cyclooxygenase-2 (COX-2) levels were decreased. To conclude, hyperuricaemic remnant kidney rats displayed improved kidney morphology and reduced markers of oxidative stress and inflammation. Thus, moderately elevated plasma uric acid had beneficial effects on the kidney in this low-renin model of experimental renal insufficiency.

Change in Serum Uric Acid is a Useful Predictor of All-Cause Mortality among Community-Dwelling Persons

There is limited research on the association between longitudinal variability in serum uric acid (SUA) and all-cause mortality in the general population, although recent studies have suggested that changes in SUA are associated with all-cause mortality in adults. This study aims to examine the association between percentage change in SUA (%dSUA = 100 × (cohort 2 SUA - cohort 1 SUA)/(time × cohort 1 SUA) and all-cause mortality. This study is based on 1,301 participants, of whom 543 were male (63 ± 11 years) and 758 were female (63 ± 9 years). We obtained adjusted relative risk estimates for all-cause mortality and used a Cox proportional hazards model, adjusted for possible confounders, to determine the hazard ratio (HR) and 95% confidence interval (CI) of %dSUA. Of all the participants, 79 (6.1%) were deceased, and of these, 45 were male (8.3%) and 34 were female (4.5%). The multivariable-adjusted HRs (95% CI) for all-cause mortality for the first, second to fourth (reference), and fifth %dSUA quintiles were 3.79 (1.67-8.48), 1.00, and 0.87 (0.29-2.61) for male participants and 4.00 (1.43-11.2), 1.00, and 1.19 (0.46-3.05) for female participants, respectively. Participants with a body mass index of <22 kg/m² had a significantly higher HR, forming a U-shaped curve for the first (HR, 7.59; 95% CI, 2.13-27.0) and fifth quintiles (HR, 2.93; 95% CI, 1.05-8.18) relative to the reference. Percentage change in SUA is independently and significantly associated with future all-cause mortality among community-dwelling persons.

The relationship between leukocyte level and hypertension in elderly patients with hyperuricemia

To evaluate the change of leukocyte level caused by hyperuricemia, and to explore the relationship between leukocyte level and hypertension in elderly patients with hyperuricemia. A cross-sectional study of serum uric acid (UA) level was conducted in 1352 elderly people over 65 years old. The samples were divided into 3 categories according to the tertiles of leukocyte: Tertile 1, leukocyte ≤ 5.2 × 109/L; Tertile 2, leukocyte = 5.3-6.3 × 109/L; Tertile 3, leukocyte ≥ 6.4 × 109/L. Multiple logistic regression models were used for modeling relationships between leukocyte, hyperuricemia and hypertension. Human vascular endothelial cells were treated by different concentrations of UA. The levels of interleukin-1 beta, tumor necrosis factor-α, endothelial nitric oxide synthase, inducible nitric oxide synthase and reactive oxygen species were measured by Western Blot or fluorescence microscope. The levels of leukocyte were higher in elderly patients with hyperuricemia than without hyperuricemia. Hyperuricemia was an independent risk factor of leukocyte in Tertile 3 (odds ratio [OR] = 1.657, 95% confidence interval [CI]: 1.180-2.328). The prevalences of hypertension were higher in elderly patients with hyperuricemia than without hyperuricemia (77.0% vs 63.5%). In the Model 1, hyperuricemia was an independent risk factor of hypertension (OR = 1.536, 95% CI: 1.026-2.302). Leukocyte in Tertile 3 was an independent risk factor of hypertension (OR = 1.333, 95% CI: 1.031-1.724). Expression levels of interleukin-1 beta, inducible nitric oxide synthase and tumor necrosis factor-α were obviously higher in the UA group than the control group, along with the productions of reactive oxygen species. But the expression level of endothelial nitric oxide synthase was obviously lower in the UA group. Hyperuricemia was associated with an increased risk for hypertension. The chronic inflammation caused by hyperuricemia maybe one of important pathogenesis of incident hypertension in patients with hyperuricemia.

Hypertensive Emergency In UMOD-Related Autosomal Dominant Tubulointerstitial Kidney Disease

Hypertensive emergency is characterized by an acute elevation in blood pressure with evidence of impending or progressive acute target organ damage. Management relies mainly on intravenous medications guided by the type of target-organ damage, but there is considerable variability in practice regarding the choice of medications and optimal therapy. Such variables include the choice of agent and the blood pressure goal, but also underlying medical conditions. We report a case of hypertensive emergency in a 39-year-old-male with a rare genetic condition, UMOD-related autosomal dominant tubulointerstitial kidney disease which gave rise to adolescent gout, worsening kidney function over decades and treatment-resistant hypertension.